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HANDOUT 2009 Missouri Cancer Summit Palliative Care


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Handout for the presentation for the Missouri Cancer Care Summit on October 8-9, 2009.

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HANDOUT 2009 Missouri Cancer Summit Palliative Care

  1. 1. Hospice & Palliative Care Missouri Cancer Care Summit October 8-9, 2009 By Christian Sinclair, MD, FAAHPM Email: Assistant Medical Director, Kansas City Hospice & Palliative Care Medical Director, Providence Medical Center Palliative Care Team Twitter: @ctsinclair Board Member, American Academy of Hospice & Palliative Medicine (& LinkedIn) Co-editor, Pallimed Contact: Cell 816.786.8895 Office: 816.941.1033 Slideshare Presentation: Slideshare Handout: Facts & Figures: 90 million Americans with serious/life-threatening illness & is expected to double over 25 years. Multiple studies demonstrate most people living with a serious illness experience • inadequately treated symptoms • poor communication with doctors • fragmented care • and enormous strains on family caregivers. Palliative care is a new medical subspecialty which addresses these gaps by focusing on symptom control and comprehensive communication about goals of care. Hospice is a type of palliative care and represents the transdisciplinary team approach. Board Certified Doctors • Palliative Medicine 2,883 (1/ 31,000 persons living with serious/life-threatening illness) (1/432 Medicare deaths from chronic illness) • Cardiologists 16,800 (1/71 heart attack victims) • Oncologists 10,000 (1/145 newly diagnosed with cancer) NHPCO Data • 2.4mil deaths annually with 0.93mil receiving hospice services (38.8%) • <7 day stay on hospice = 30.8% of those served by hospice • >180 days on hospice = 13.1% died or discharged • Median length of stay on hospice was 20.0 days • Mean length of stay on hospice was 67.4 days • 70% of hospice enrollees die in place of residence • Hospice has lower than expected utilization with non-white patients (18.7%) and Medicaid patients (4.5%) • Evaluation of hospice services are routinely rated very highly in satisfaction Duke/Taylor Study on Hospice: • Hospice services reduced Medicare costs by an average of $2,309 per hospice patient. • Costs would be reduced for 7 out of 10 hospice patients if hospice used for a longer time. • BUT cost savings is not the primary reason to refer utilize hospice
  2. 2. • Cost savings shows a shared decision making approach leads to good cost-effective care
  3. 3. CAPC Data States where there is greater access to palliative care programs, patients: • Are less likely to die in the hospital • Experience fewer ICU/CCU admissions in the last six months of life • Spend less time in an ICU/CCU in the last six months of life Missouri gets a ‘B’ for Palliative Care Access Other Facts: • Palliative Medicine Doctors Serving MO: 15 – Kansas City, 12 – St. Louis 3 – Columbia, 2 – Springfield, 1 - St. Joseph, 1- Maryville State Policy Recommendations (from Center to Advance Palliative Care): • Fund palliative care (PC) team training & technical assistance for all hospitals • Include PC indicators in state quality programs • Ensure the development of PC programs in public and sole community provider hospitals o Since they provide care to the underserved & most vulnerable populations • Require all state-supported medical schools to have affiliations with hospital PC programs. • Create a statewide resource center for promotion of access to quality PC services o See NY Palliative Care Training Act-Public Health Law Article 28 • Require physicians take CME on pain management and care of the terminally ill. o See CA Business and Professions Code section 2190.5. Resources: • American Academy of Hospice & Palliative Medicine AAHPM – • National Hospice & Palliative Care Organization NHPCO – • Missouri Hospice and Palliative Care Organization MHPCA – • Center to Advance Palliative Care CAPC – • Hospice and Palliative Nurses Association HPNA • Pallimed – References: • NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care Organization, October 2008. • Center to Advanced Palliative Care. • D.H. Taylor Jr et al. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Social Science & Medicine 65 (2007) 1466–1478. (full pdf link)